NPIMap

Organization Active NPI

Eye Clinic of Bellevue LTD PS

Doing business as Overlake Optical

  • Eyewear Supplier
  • Bellevue, WA
National Provider Identifier
1093830648
Registry record updated Aug 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
07392 Issued in WA
Legal business name
EYE CLINIC OF BELLEVUE LTD PS
Doing business as
Overlake Optical
Practice address
1300 116TH Ave NE
Bellevue, WA 98004-3808
Phone
(425) 454-7989
Fax
(425) 454-7915
NPI assigned
Mar 20, 2007
Last updated
Aug 25, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Karin Polzin
Title
Office Manager
Phone
(425) 454-3133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 07392 WA Primary

Addresses

Primary practice location

1300 116TH Ave NE
Bellevue, WA 98004-3808

Mailing address

1300 116TH Ave NE
Bellevue, WA 98004-3808
Phone (425) 454-7989

Other names 1

  • Overlake Optical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930062952 WA DME Supplier - Physician - OptometristDME Supplier - Optician 5991694192 Practice locations: Bellevue, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Overlake Optical1300 116TH Ave NE, Bellevue, WA 98004-3820(425) 454-7989 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Eye Clinic of Bellevue2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1300 116th Ave NE
Bellevue, WA 98004
Phone (425) 454-7912

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314230400000",
    "number": "1093830648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 116TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043808",
            "telephone_number": "425-454-7989",
            "fax_number": "425-454-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 116TH AVE NE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043808",
            "telephone_number": "425-454-7989",
            "fax_number": "425-454-7915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CLINIC OF BELLEVUE LTD PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2011-08-25",
        "status": "A",
        "authorized_official_last_name": "POLZIN",
        "authorized_official_first_name": "KARIN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "425-454-3133",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "WA",
            "license": "07392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Overlake Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.